x. Arousal dys.

Deficient genital congestion in women can lead to dyspareunia (pain during intercourse),which detracts from sexual pleasure and may result in anorgasmia. Deficient genital congestion in women can be defined as the absence of vulval congestion or vaginal lubrication regardless of the type of stimulation experienced, resulting in reduced sensation when the genitals are touched, but with a feeling of arousal during non-genital stimulation. Deficient genital congestion is well described among women with diabetes, pre-menopausal women with mild hypertension (regardless of the treatment), and women undergoing regular dialysis. The problem persists even after a kidney transplant, although there is likely to be some improvement in the subjective feeling of arousal.
Oestrogen deficiency has long been associated with reduced lubrication. Plethysmography reveals that this correlation only applies at rest; during erotic stimulation the increase in congestion is the same regardless of whether there is any vaginal wall atrophy. This also applies to changes in the vaginal wall and the clitoris during sexual stimulation. Oestrogen deficiency in itself does not exclude adequate lubrication provided there is adequate stimulation. If the degree of stimulation is not sufficient, the complaint does become more manifest in cases of atrophy.